Delivering Trouble

By Kinsey Grant

Williams with her family. Photo courtesy of Jodi Williams

Kate’s birth wasn’t the first traumatic delivery for Williams, who is a human resources employee of Washington and Lee University. Her second child was born in a bathroom in Augusta Health—seven minutes after she got to the hospital. She’d been told to urinate in a cup for routine testing, but never made it to a bed.

For two of her three children’s births, Williams prepared to deliver with four different nurses because of the health center’s rotating schedule.

“You never know who you’re going to deliver with,” she said. “It would be nice to pick and choose because there were nurses I liked more than others.”

For checkups throughout her pregnancy, Williams went to Augusta Health Care for Women, a privately owned practice in Fishersville. It is not part of the Augusta Health system. But doctors in the Fishersville practice have in-patient privileges at the hospital, Augusta Health, which is part of the system.

Roxanne Harris, a labor and delivery nurse at Augusta Health, said the hospital uses flex staffing. This means that the unit sends nurses and midwives home if there are few women checked in and about to deliver a baby. They also call in extra staffing when the unit is particularly busy.

But servicing women from both Augusta and Rockbridge counties often means a tight schedule for the labor and delivery unit.

Limited options lead to more intervention

Until April 2010, Rockbridge County women had the option of delivering at Carilion Stonewall Jackson Hospital’s labor and delivery unit in Lexington. When the birthing center closed, women’s options disappeared.

Charles Carr, Carilion Stonewall Jackson’s chief executive officer, said the birthing center closed because it was too expensive to maintain for the small number of babies born there annually. About 60 to 70 percent of women were leaving Rockbridge County to deliver.

State laws also required staffing minimums regardless of the number of babies being born at any given time.

“It’s not something we wanted to do. But I think we were kind of forced into a situation where we didn’t have a lot of other options,” Carr said.

Williams delivered her first child at Stonewall Jackson in 2005, five years before the birthing center closed.

During labor, Williams’ doctor decided that the baby needed to be born quickly and used forceps. Williams said she had been pushing for only 45 minutes, which is not much time for a first-time mother.

“If I had known better, I would have absolutely fought,” Williams said.

A delivery with forceps is often harder on the mother, she said. Forceps deliveries result in more tearing than would occur with natural, unmedicated births. Risks also include difficulty healing and even anemia and incontinence for the mother, the Minnesota-headquartered Mayo Clinic says on its website.

Caroline Russell had a different experience with her three children—who are now 12, 14 and 16—at the Stonewall Jackson birthing center.

“Doctors were more willing to wait for a natural birth to occur,” she said.

Russell said few of her friends who had babies at Stonewall Jackson received epidurals. The regional anesthetic in epidurals blocks pain and decreases sensation in the entire lower half of the body, according to the American Pregnancy Association.

Russell opposed getting an epidural or taking any drugs. She felt it would drug her baby, as well.

She said doctors at Stonewall Jackson viewed medical intervention as a last resort and instructed women to consider other options before requesting an epidural or Cesarean delivery.

Experiences at Stonewall Jackson varied. But seven years after the labor and delivery unit closed, women are still forced to leave Rockbridge County to have a baby.

Hoping for the best, preparing for the worst

Jenni Sexton had her second child, Lethea, about a month ago at Augusta Health in Fishersville. Sexton and her family live in Fairfield, which is about 30 minutes from Fishersville. But even with a scheduled Cesarean section, she worried that her baby would be born before she made it to the hospital.

Most women with planned C-sections deliver right at 39 weeks. But scheduling conflicts with Sexton’s doctor meant she had to push her delivery to 40 weeks.

Even if a woman can make the drive to Fishersville, the baby still might not arrive when expected.

Jarrod Hill, a firefighter and paramedic for the city of Lexington, delivered a baby in 2016 after the mother was told to leave Augusta Health. At 40 weeks pregnant, she thought she was ready to deliver. But doctors told her otherwise.

She made it home. But her baby boy was born in the driveway—inside the ambulance.

Hill said he learned how to deliver a baby during fire and emergency medical training. It’s a basic skill that even the most junior firefighters and emergency responders learn. Labor simulations teach routine deliveries, along with the abnormal breech births. Emergency responders are also taught how to deliver a baby that is partially out of the birth canal.

If something goes wrong, Hill and other EMTs take most emergency patients to Stonewall Jackson.

Stonewall Jackson is not trauma certified and lacks a newborn intensive care unit. But it has a helicopter for emergency medical transport, something unusual for a town as small as Lexington.

“We can get the mother and the baby on the helicopter and get them to Roanoke or Augusta in 10 or 15 minutes tops,” Hill said.

The absence of a newborn intensive care unit at Stonewall Jackson means that mothers and babies who face complications must go to Stonewall Jackson to be evaluated. They’re then transported to Roanoke Memorial or other nearby hospitals with specialty services.

New trends: alternatives to hospital birth

Without the means to give birth here, a growing number of women in Rockbridge County are electing to deliver their babies in alternative ways. This includes home births with a midwife, unassisted home births, and the use of doulas, who are trained to provide physical and emotional support throughout a delivery, but can’t give medical care.

Midwives provide mothers with individualized education, counseling, prenatal care and continuous hands-on assistance during labor and delivery, along with postpartum support, according to the Midwifery Task Force. The non-profit group is an alliance of professional midwives across the United States.

Emily Friar with an infant. Photo courtesy of Emily Friar

As a certified professional midwife, Emily Friar is trained to assist women during childbirth at home. Since Friar began practicing as a certified professional midwife in 2003, she assists with an average of 10 to 15 births per year. But Friar does not practice in hospitals and cannot carry or administer medications.

Lynchburg midwife Leslie Payne said certified professional midwives have been popular in Virginia since the 1920s. During that time, home births were often the choice for black or low-income women who couldn’t afford a trip to the hospital.

The steady trend of alternative deliveries has sparked change in traditional hospital births, Friar said. Women have started to value more traditional births and reject the heavily medicated births of the last few decades. Midwives focus their woman-centered model of care on minimizing technical interventions and trauma.

“Now we’re trying to go back to a place we used to be,” Friar said.

Before heavy dose anesthetics or forceps deliveries, women had babies without any medication.

Some hospitals offer clear drapes for Cesarean births to allow the mother to see more of what’s happening to her body, delay cord clamping until the placenta is delivered, and initiate skin-to-skin contact between mother and child immediately. Friar says such steps lead to lower rates of postpartum depression, and result in better microbiological outcomes and stronger bonding between mother and baby.

Nurses at Augusta Health in Fishersville learn to use new fetal monitoring technology

Harris, a labor and delivery nurse at Augusta Health, said her unit has added Jacuzzis and birthing stools to cater to a woman’s needs, especially if she doesn’t want to deliver in a hospital bed with her feet in the stirrups.

“Over the last few years, there have been so many changes to what hospitals are doing largely because women are going out of the hospital to have their babies,” Friar said.

Mariam Todd, 40, of Montebello—about halfway between Lexington and Fishersville—knew she wanted to give birth at home, starting with the first of her five children. But in 2002, it wasn’t so easy to find a midwife.

Friar said lay midwives, or midwives who are not certified by any regulatory exams or state boards, are especially conscious of the potential risk in taking on a first-time mother as a client. There is no history of labor to rely on, and the chance for something to go wrong is high.

Todd was six months’ pregnant when she found Charlottesville-based midwife Brynne Potter. But Potter told Todd that most midwives would be reluctant to help if they weren't licensed—and that she might get arrested if things went south.

“She was worried that her kids would be without a mom for a while,” Todd said.

But Potter delivered Todd’s first child without any complications. Todd later gave birth to four other children, all at home. She didn’t have a midwife for the birth of her fourth child, only the help of her husband, Michael, who is the technology operations manager for the journalism department at Washington and Lee University.

Delivering a child in a hospital was “never in the sphere of thought,” Todd said.

Todd grew up in Pakistan, and home birth was all she knew there. Most Pakistani women only go to the hospital if there are complications.

“You only go to the hospital to die,” she said.

For Lexington native Jessica Wager, traveling to deliver at Augusta Health was an option she only briefly considered. She’s set to deliver any day now.

After routine checkups at Augusta Health early in her pregnancy, Wager knew it wasn’t the place for her

“I didn’t think they would keep my dreams of delivering vaginally in mind,” she said.

Harris said one-third of the babies born there are delivered via Cesarean section.

Wager found Emily Friar through her partner’s mother, who used to be a doula. Though Wager’s sisters had positive experiences delivering in hospitals, she wanted something more natural and low stress.

“[Friar] is calm, she’s intelligent and she’s informed. She reminds you to be flexible. … She wasn’t so dogmatic about doing it one way,” Wager said.

Friar’s philosophy is centered on compromise. She says she respects women’s wishes, but reminds them that if something goes wrong, they’re going to get medical help from a nearby hospital.

Each client Friar takes on is responsible for developing an emergency care plan with her ahead of time. The plan identifies the closest medical facilities and includes calculations about how long it will take to get there.

Midwives are trained to be “autonomous,” Payne said. But if she sees any indication that things might not go according to plan, she brings the woman to the hospital.

“We don’t want to take any unnecessary chances,” Payne said.

Friar said she visits clients weekly toward the end of the pregnancy. When contractions are five minutes apart, the client calls Friar to her home.

She then helps with delivery and stays with the woman for up to six hours to help with initial care and walk the mother through nursing her baby for the first time.

The next day, Friar visits the home again. She returns at three days, two weeks and six weeks postpartum. For first-time mothers, she makes as many additional visits as the woman wants.

Wager, like many local women, has decided that she won’t take her child to a pediatrician in Lexington after her baby is born.

Traveling to Valley Pediatrics in Waynesboro is a “trek,” Wager said, especially the day after delivering.

Friar’s home visits to check on mother and baby in the days immediately following delivery reduce the stress of taking a brand new infant on the highway or on Route 11, Wager said.

Wager said she finds women’s health care in this area to be “subpar.” The only good thing she has to say about it is Friar’s work.

Midwife Payne said without a permanent obstetrician in Rockbridge County, women have to deal with obstacles to accessing care even when they aren’t pregnant.